Levetiracetam

SV2A Ligand·Neurology - Anticonvulsants

Focal and generalized seizures, status epilepticus

Authority requiredPBSANTICONVULSANTKeppra1000 mg tablet+2

Max Dose

3000 mg/day

Half-life

6-8 h

Psych Risk

KEPPRA RAGE

Renal Adj.

DOSE RED.

Rapid Summary

Overview

Broad-spectrum anticonvulsant. The most commonly prescribed first-line seizure medication on the ward due to its lack of hepatic drug interactions and rapid IV loading capability.

Maximum Dose

Max 3000 mg/day (given in divided doses).

Clinical Focus

Renally cleared. Causes severe, uncharacteristic psychiatric side effects (aggression/rage) in a minority of patients.

Bottom Line

Levetiracetam is a first-line broad-spectrum anticonvulsant with minimal drug interactions and no monitoring, but commonly causes behavioural disturbance including irritability and aggression.

Formulation & Access

Brand Names

Keppra

Oral Routes

Tablets (250, 500, 1000 mg). Oral liquid (100 mg/mL).

Parenteral

Ampoules (500 mg/5 mL) for IV infusion.

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Focal and generalized seizures, status epilepticus.

Clinical Place

The gold standard for acute ward seizure prophylaxis post-TBI, stroke, or craniotomy. Displacing Phenytoin due to a vastly superior safety profile.

Quick reference

Class & Role

SV2A Ligand — Broad-spectrum anticonvulsant.

Route / Formulation

Tablets (250, 500, 1000 mg). Oral liquid (100 mg/mL). (Keppra)

Usual Dose & Max

IV 40-60 mg/kg STAT (Max 4500 mg load). Infuse over 15 mins.

Key Indication Doses

Status Epilepticus / Acute Load: IV 40-60 mg/kg STAT (Max 4500 mg load). Infuse over 15 mins. Epilepsy Maintenance: PO 250-500 mg BD. Titrate every 2 weeks to Max 3000 mg/day. Renal Impairment: If eGFR 30-50, Max 750 mg BD. If eGFR < 30, Max 500 mg BD.

Best Uses

Levetiracetam is a first-line broad-spectrum anticonvulsant with minimal drug interactions and no monitoring, but commonly causes behavioural disturbance including irritability and aggression.

Avoid / Cautions

Previous severe hypersensitivity or severe psychiatric reaction to the drug. Pregnancy Category B3. One of the safest anticonvulsants in pregnancy alongside Lamotrigine. Clearance increases during pregnancy, requiring dose escalation.

Key Risks

Psychiatric: 'Keppra Rage': irritability, severe aggression, depression, psychosis, suicidal ideation (affects ~10% of patients). Neurological: Somnolence, asthenia (weakness), dizziness (mostly during initiation). Hepatic: Zero hepatic enzyme induction or inhibition.

Key Interactions

Essentially zero drug-drug interactions. Safe to mix with all other anticonvulsants, OCPs, and DOACs.

Monitoring

Ask family/patient specifically about mood changes or aggressive outbursts. If present, switch to Brivaracetam or Sodium Valproate. Check eGFR to guide dosing.

Clinical Pearl

If a patient's seizures are perfectly controlled on Levetiracetam but they are experiencing severe 'Keppra Rage', switch them overnight to Brivaracetam (Briviact). It hits the same receptor but is significantly more lipophilic, causing a fraction of the psychiatric side effects.

Access

Authority requiredKeppra1000 mg tablet

Brand: Keppra
PBS status: Authority required
Formulation: Tablets (250, 500, 1000 mg)

Levetiracetam

SV2A Ligand·Neurology - Anticonvulsants

Focal and generalized seizures, status epilepticus

Authority requiredPBSANTICONVULSANTKeppra1000 mg tablet+2

Max Dose

3000 mg/day

Half-life

6-8 h

Psych Risk

KEPPRA RAGE

Renal Adj.

DOSE RED.

Rapid Summary

Overview

Broad-spectrum anticonvulsant. The most commonly prescribed first-line seizure medication on the ward due to its lack of hepatic drug interactions and rapid IV loading capability.

Maximum Dose

Max 3000 mg/day (given in divided doses).

Clinical Focus

Renally cleared. Causes severe, uncharacteristic psychiatric side effects (aggression/rage) in a minority of patients.

Bottom Line

Levetiracetam is a first-line broad-spectrum anticonvulsant with minimal drug interactions and no monitoring, but commonly causes behavioural disturbance including irritability and aggression.

Formulation & Access

Brand Names

Keppra

Oral Routes

Tablets (250, 500, 1000 mg). Oral liquid (100 mg/mL).

Parenteral

Ampoules (500 mg/5 mL) for IV infusion.

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Focal and generalized seizures, status epilepticus.

Clinical Place

The gold standard for acute ward seizure prophylaxis post-TBI, stroke, or craniotomy. Displacing Phenytoin due to a vastly superior safety profile.

Quick reference

Class & Role

SV2A Ligand — Broad-spectrum anticonvulsant.

Route / Formulation

Tablets (250, 500, 1000 mg). Oral liquid (100 mg/mL). (Keppra)

Usual Dose & Max

IV 40-60 mg/kg STAT (Max 4500 mg load). Infuse over 15 mins.

Key Indication Doses

Best Uses

Levetiracetam is a first-line broad-spectrum anticonvulsant with minimal drug interactions and no monitoring, but commonly causes behavioural disturbance including irritability and aggression.

Avoid / Cautions

Key Risks

Key Interactions

Essentially zero drug-drug interactions. Safe to mix with all other anticonvulsants, OCPs, and DOACs.

Monitoring

Ask family/patient specifically about mood changes or aggressive outbursts. If present, switch to Brivaracetam or Sodium Valproate. Check eGFR to guide dosing.

Clinical Pearl

Access

Authority requiredKeppra1000 mg tablet

Brand: Keppra
PBS status: Authority required
Formulation: Tablets (250, 500, 1000 mg)